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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �D Permit Number: �vD.YS7LO/ • R E •,:.. :__._ Building Permit Application AUG 3 0 2016 Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PROP'QSEb-.IMPROVEMENT LOCATION Address: Legal Description: Property Tax ID#: © s- Q - (C _ Lot No. Site Plan Name: T ] Block No. Project Name: Go-r-0 J-1 71lT Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION M WORK f� Is--m LL (�e 3O CONSTRUCTION INFORMATION: Additional work to be pertormed under this permit-check all that appy: _HVAC `Gas Tank _Gas Piping _Shutters _Windows/Doors _ElectricPlumbing _Sprinklers _Generator _Roof Roof pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ 1 , cZo Utilities: —Sewer _Septic Building Height: OV1/NER/LESSEE: CONTRACTOR;. Name. Q��cc�l � �,,���To c`� Name: � k� Ago k�a�GC> , IV Address: IIJOI� R2L2.bq" Company: 'i) 1VSSOL3 P043e Lv, N City: R i'Qx ccs State:'j Addre s: Q O , Q;5Zc ') I) Zip Code: 3 '���-a, Fax: City: �2_�r S' )-\/\,Z.I r-- Stater L Phone No. ` �'� G 1 15 ti) I Zip Code: 3 y Fax: T)a- -),249 E-Mail: Phone No. "n D' -'ITS 3 Fill in fee simple Atle Holder on nexi page if different E-Mail: '�e�Lke GO @ 1 D N oa . Car-i from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEII�/II RA I GOON-v yb,01 0LIENGLA�W�IN,F `R'MATION``� t 4 F3 � ,..r r -"` m +• ,,, j.., 'i _.. DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: k Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _-,-g Not Applicable BONDING COMPANY: k Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: I certify that no work or installation has commenced prior to the issuance of a permit. St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review:room additions, accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. J�10(�� s Signature of Owner/Lessee/Contractor as Agent fo Cae $: Signature of Contractor/License Holder STATE OF FLORIDA - ,�f t , STATE OF FLORIDA COUNTY OF \34- /�-�/ COUNTY OF d •C-f��— °�:` ''' MTZ The forgoing instr nt was acknowledged befor 9 9 The r ping instr9riffont was acknowledged before _��g 2 27�y this day of 20f�by ny m thi day of 2010 by ti� d �10 Q e� Y1 �a cs D ll� �T (Name of person acknowledging) (Name of person acknowledging) • _o p �N (Signature ofo#ary Pub' -State of Florida) (Signature ofyotary Public-State of Florida) Personally Known OR Pro c Iden •fication Personally Known OR Prod a denti ation / Type of Identification Produced Type of Identification Produced Commission No. (Seal) Commission No. (Seal) Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS